Example

FORM 3
SUMMARY INTERIM ASSET REPORT

Trustee:

Jenny Ward

Blanket bond amount:

$10,000,000.00

For Period Ending:

6/30/03

Per case limit:

$750,000.00

1

Case No.

416-00-73862
416-02-71545
416-02-75484
416-02-03008
416-03-04532
416-03-07898

2

Case Name

Smith Supply Company
Neal, Bob and Jane
Martin, Sam dba Martin Cards
Jones, Tom & Carol
Martin, Steve
Lewis Auto

3

Date filed (f) or
converted (c)
to chapter 7

3/15/01 (c)
5/6/02 (f)
11/20/02(f)
1/3/03 (c)
3/13/03 (f)
4/10/03 (f)

TOTALS:

4

5

Total funds on

deposit or invested
(from Form 2)

1,500.00
-074,489.76
-0506,683.00
850,000.00

Amount of
separate bond
(if any)

6

Gross value of
remaining assets
(from Form 1–
excludes unknown
values)

1,000,000.00

1,432,672.76

I certify that I have filed and reviewed Forms 1 and 2 for all cases listed above and that they are accurate and correct to the best of my knowledge.
Trustee's signature:

Date signed: 7/23/03

-0-040,000.00
-075,000.00
500,000.00

615,000.00

7
Date of Actual Disposition by*:
Final Report (TFR)
Final Account (TDR)
Report of No Distribution (NDR)

Conversion (C)
Dismissal (D)
Reassignment (R)
*If TFR not filed, insert estimated (e)
TFR date.

6/3/03 TFR
5/15/03 TDR
6/30/04 TFR (e)
6/25/03 NDR
12/31/04 TFR(e)
2/8/05 TFR (e)